Medical Claims Paid by Workers’ Compensation Insurance Among US Medicare Beneficiaries, 1999–2016

Details

• Personal Author:
  Blackley DJ ; Casey M ; Chin B ; Halldin, Cara N. ; Kurth L ; Mazurek JM ; Schleiff, Patricia L.
• Description:
  Background: Workers' compensation claims among Medicare beneficiaries have not been described previously. To examine the healthcare burden of work-related injury and illness among Medicare beneficiaries, we assessed the characteristics, healthcare utilization, and financial costs among Medicare beneficiaries with claims for which workers' compensation was the primary payer. Methods: We extracted final action fee-for-service Medicare claims from 1999 to 2016 where workers' compensation had primary responsibility for claim payment and beneficiary, claim type, diagnoses, and cost information from these claims. Results: During 1999-2016, workers' compensation was the primary payer for 2,010,200 claims among 330,491 Medicare beneficiaries, and 58.7% of these beneficiaries had more than one claim. Carrier claims submitted by noninstitutional providers constituted the majority (94.5%) of claims. Diagnosis codes indicated 19.4% of claims were related to diseases of the musculoskeletal system and connective tissue and 12.9% were related to disease of the circulatory system. Workers' compensation insurance paid $880.4 million for these claims while Medicare paid $269.7 million and beneficiaries paid $37.4 million. Conclusions: Workers' compensation paid 74% of the total amount to providers for these work-related medical claims among Medicare beneficiaries. Claim diagnoses were similar to those of all workers' compensation claims in the United States. Describing these work-related claims helps identify the healthcare burden due to occupational injury and illness among Medicare beneficiaries resulting from employment and identifies a need for more comprehensive collection and surveillance of work-related medical claims. [Description provided by NIOSH]
• Subjects:
  Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Author Keywords: Medical Claims Costs Health Care Injuries Medicare MSD Musculoskeletal System Disorders Surveillance Work-related Injuries Workers' Compensation Workers Compensation

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• ISSN:
  0271-3586
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Ohio ; OSHA Region 3 ; OSHA Region 5 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  RHD - Respiratory Health Division ; NPPTL - National Personal Protective Technology Laboratory ; DFSE - Division of Field Studies and Engineering
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  185-191
• Volume:
  64
• Issue:
  3
• NIOSHTIC Number:
  nn:20061857
• Citation:
  Am J Ind Med 2021 Mar; 64(3):185-191
• Contact Point Address:
  Laura Kurth PhD, Surveillance Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Frederick Ln, Mailstop HG900.2 Morgantown, WV 26508, USA
• Email:
  lkurth@cdc.gov
• Federal Fiscal Year:
  2021
• NORA Priority Area:
  Mining
• Peer Reviewed:
  True
• Source Full Name:
  American Journal of Industrial Medicine
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:4113d0bfb47c23b1556c58358c9a0572448b359587e06d53a31cffe04be1ee137b203073e43047f8efca17a1439dd479359ebff3b785f47b454a3a43eb767979
• Download URL:
  https://stacks.cdc.gov/view/cdc/225217/cdc_225217_DS1.pdf
• File Type:
  [PDF - 653.97 KB ]